CN102858228A - Advancing system and method of use thereof - Google Patents
Advancing system and method of use thereof Download PDFInfo
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- CN102858228A CN102858228A CN201080064021XA CN201080064021A CN102858228A CN 102858228 A CN102858228 A CN 102858228A CN 201080064021X A CN201080064021X A CN 201080064021XA CN 201080064021 A CN201080064021 A CN 201080064021A CN 102858228 A CN102858228 A CN 102858228A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00089—Hoods
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00098—Deflecting means for inserted tools
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00101—Insertion part of the endoscope body characterised by distal tip features the distal tip features being detachable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00137—End pieces at either end of the endoscope, e.g. caps, seals or forceps plugs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/0014—Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
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- General Health & Medical Sciences (AREA)
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Abstract
A system is provided for advancing medical devices along an endoscope to a selected target anatomy in a patient. The advancing system includes a tether having a first portion disposed through a working channel of an endoscope and a second portion disposed external the endoscope. The advancing system may include a guiding device configured to advance a medical device beyond a distal portion of the endoscope to a selected target anatomy.
Description
Technical field
The present invention relates to armarium, relate more specifically to a kind of propulsion system and using method thereof, be used for along endoscope armarium being transported to the selected target body part.
Background technology
The doctor manifests body area, diagnoses various situations and device is transported to treatment position with endoscope in the process of Minimally Invasive Surgery.Typically the service aisle via endoscope comes conveying equipment, the diameter of this service aisle is usually in about scope of 2.0 to 3.5mm, and these equipment can be for guide catheter and other elongated equipment that comprises tweezers, shears, brush, snare and basket.In some special-purpose endoscope, can obtain the larger service aisle of diameter 5.0mm, and these service aisles can be used for by relatively large equipment or the air-breathing or reduced pressure capabilities of raising is provided.Yet some equipment is for no other reason than that excessive and can not pass available endoscope.And the special-purpose endoscope price with larger service aisle can be very expensive, and be difficult to insert pipe owing to rigidity and external diameter increase.
The excessively large equipment that is used for endoscopic working channel must and be imported into through alternative normally more traumatic operation, for example laparoscopy or open operation.Laparoscopic surgery is included in the otch that cuts 0.5-1.5cm in patient's stomach wall, thereby peritoneoscope and other device can be imported in abdominal cavity and the pelvic cavity.Open operation is usually included in the patient and cuts one or more long otch with it, then peels off muscle on a large scale, and retracting tissue for a long time denervates and tissue is carried out disconnection.Although effectively imported larger equipment, laparoscopic surgery and open surgery can increase the risk of complication for patients and wound, can prolong cure time and hospital stays simultaneously.
Needed is to need not to use trauma operation and the excessive armarium that is used for the endoscope service aisle carries out equipment and the method that endoscope imports.Especially, need equipment and method to come to import armarium along endoscope and in the outside of endoscope.
Summary of the invention
Equipment disclosed herein and method are used for armarium is imported in the body area, and more specifically to along the endoscope outside armarium being advanced to the selected target body part.Usually, described propulsion system comprises for the rope along endoscope's puopulsion equipment.Described propulsion system may further include for the guiding elements that equipment is advanced the distal part that surpasses described endoscope.Equipment can be connected to described rope, is advanced to afterwards the distal end of described endoscope, and in certain embodiments, is advanced to the distal end of described guiding device, is preferably to be advanced in the selected target body part.
In one aspect, provide a kind of system, be used for armarium is advanced to the selected target body part of patient body.In one embodiment, described propulsion system is suitable for using with endoscope, described endoscope has portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, and described port is arranged on described proximal portion and is communicated with described service aisle.Described propulsion system comprises rope, and described rope extends to described hole from described portions of proximal to described distal part in described endoscope outside, and through described service aisle and outside described hole extends to described port and described port.
In another embodiment, described propulsion system comprises guiding device, and described guiding device comprises: the elongated axle, and described elongated axle has portions of proximal and distal part; Fulcrum, described fulcrum are arranged on described extremity office and are configured to and receive rope through described fulcrum; Variable durometer cable, described variable durometer cable are arranged on the described elongated axle; And actuator, described actuator is set to contiguous described portions of proximal.Described variable durometer cable comprises: helical spring, and described helical spring extends to distal part from the portions of proximal of described elongated axle; And silk thread, described silk thread extends past described spring.Preferably, described silk thread functionally is connected to described spring in described extremity office.Be connected to described actuator operated described silk thread.
In yet another aspect, provide a kind of method, be used for armarium is advanced to the selected target body part of patient body.In one embodiment, described method comprises: endoscope is advanced to the selected target body part, armarium is connected to rope, and utilize described rope to advance described armarium along described endoscope.Described endoscope comprises portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, and described port is arranged on described proximal portion and is communicated with described service aisle.During beginning, described rope extends to described hole from described portions of proximal to described distal part in described endoscope outside, and through described service aisle and outside described hole extends to described port and described port.By pulling out described rope through described port, can will connect armarium along described endoscope and be advanced to described distal part from described portions of proximal.
In another embodiment, described method can comprise: through described service aisle seal wire is advanced to described hole, is advanced to afterwards the target body part of the distal part that surpasses described endoscope.Guiding device can be advanced to described hole through described service aisle, is advanced to afterwards the target body part of the distal part that surpasses described endoscope.Armarium can be advanced to described target body part along described guiding device.
On the basis of the drawings and specific embodiments below the research, those skilled in the art will know other system, method, feature and advantage.All these other systems, method, feature and advantage all are intended to be contained within this description, fall within the scope of the present invention, and are subject to the protection of appended claims.
Description of drawings
To understand better this system with describing with reference to the following drawings.Part in each accompanying drawing need not be proportional, and emphasis is to show principle of the present invention.And in each accompanying drawing, same Reference numeral represents to run through the corresponding component in the different views.
Figure 1A has shown propulsion system 100.
Figure 1B has shown equipment 120.
Fig. 2 A-2B has shown the guided rings 200 that is arranged in the endoscope 102.
Fig. 2 C has shown the axonometric chart of guided rings 200.
Fig. 2 D has shown the cross-sectional view of the guided rings 200 that the line aa in Fig. 2 C presents.
Fig. 3 A-3C has shown guiding device 300.
Fig. 3 D has shown guiding device 300 has been attached on rope and the seal wire.
Fig. 3 E-3F has shown the alternate embodiment of guiding device 300.
Fig. 3 G has shown the elongated member 302 that is advanced in the target body part 380.
Fig. 4 A-4B has shown the endoscope cap 400 with fixed ramp.
Fig. 4 C-4E has shown the endoscope cap 400 with the slope that can pivot.
Fig. 4 F has shown connecting rod 440.
Fig. 5 A has shown endoscope sheath 500.
Fig. 5 B-5C has shown medicated cap member 530.
Fig. 5 D has shown the coupling member 550 that is connected to tube chamber 520.
Fig. 6 A-6H has shown and utilizes propulsion system 100 that large plastics gallbladder support is transported in the common bile duct.
The specific embodiment
Definition
Unless otherwise defined, the implication of employed all technology of this paper and scientific terminology is identical with the common implication of understanding of the those of ordinary skill in field, place of the present invention.In the situation that there is conflict, will be as the criterion with this paper that comprises each definition.Method for optimizing and material are described below, but can use in practice of the present invention or test or the method and the material that are equal to similar with material to methods described herein.Material disclosed herein, method and example only are illustrative and be not to be intended to limit.
As used herein, term " comprises ", " comprising ", " having ", " containing ", " having ", " including " and modification thereof are intended to transition wording, term or word as open purpose, and it does not get rid of additional action or the probability of structure.The present invention also can imagine " comprising " embodiment described herein or key element, " by " other embodiment of its " formation " and " mainly by " its " formation ", no matter whether it is explicitly pointed out.
As used herein, term " biocompatible " means material substantially nontoxic in the biotic environment of its purpose purposes, and this material can not repelled by patient's physiological system substantially.In the time of in importing to the Most patients health, biocompatible structure or material will can not cause unacceptable disadvantageous, physiological reaction or response long-term or that increase.Such response is different from gentle temporary transient inflammation, and the latter typically follows outer surgical operation or foreign body is implanted in the live body and occurs.
As used herein, term " distally " means the direction of basic target location within body area in the process of medical operating.
As used herein, term " nearside " means basic direction towards the doctor in the process of medical operating.
As used herein, term " narrow " means the tube chamber of health with respect to any section that narrows that adjoins the tube chamber part.
Specifically describe
Figure 1A has shown the propulsion system 100 that comprises rope 104.Propulsion system is suitable for using with endoscope 102.The service aisle 110 that endoscope 102 has portions of proximal 106, distal part 108 and extends to distal part from portions of proximal.Service aisle is connected to the hole 112 that is arranged on the extremity office.Rope 104 externally extends to distal part 108 from portions of proximal 106 along endoscope, and enters service aisle 110 via hole 112.The extension of rope process service aisle is got back to portions of proximal 106 and is left at port one 14 places.Rope comprises first end 105 and the second end 107.Rope can comprise the connection element 116 that is preferably located in the second end 107 places.Connection element can be attached to rope 104 or form with rope 104 integral body.Connection element can for example be attached to rope by cementing, bonding or stitching.
Figure 1B has shown the equipment 120 that can be transported to the selected target body part.Equipment 120 is intended to usually represent can be by any equipment of propulsion system conveying of the present invention.Equipment 120 can be to be suitable for providing the equipment for the treatment of or diagnosing for the selected target body part, perhaps alternately can be configured for the equipment that another treatment or diagnostic device is transported to the selected target body part.Equipment 120 for example can be J section, colon solution pressure pipe, gallbladder support, delivery conduit, trocar sheath, conductor sheath or the another kind of equipment of nasointestinal tube, PEG-J pipe.Equipment 120 comprises proximal end 124, distal end 126, and can have the complementary connection element 122 that is and is configured to connect with connection element 116.Alternately, connection element 122 can be configured to directly be attached to rope 104.Will more specifically make an explanation as following, in case the selected target body part has arrived in endoscope 102 and equipment 120 has been connected to rope, just can equipment be advanced to by retracting rope from port one 14 through service aisle 110 distal part of endoscope.Preferably, coming with rope in its distal end 126 pulling, can be from its proximal end 124 pushing equipments 120.
Connection element 116 and 122 can comprise any suitable structure that is configured to temporarily connect two armarium.For example, connection element can comprise closed-loop structure, shown in Figure 1A-1B.Connection element can comprise the releasable stitching thread that maybe can rupture, temporary transient or soluble binding agent or binding agent, magnet or its combination.Connection element can comprise biocompatible ball, this ball shrinkage, cementing or otherwise be designed to the motive force (for example, 3 pounds) of the q.s that applies and landing or split, and can pass safely gastrointestinal system afterwards or be absorbed.Alternatively, equipment 120 can for example utilize stitching thread that can rupture or soluble and directly be connected to rope.
Fig. 2 A-2B has shown the guided rings 200 that arranges along the outer surface of endoscope 102.Preferably, rope is along with it moves and pass guided rings along endoscope, thereby closely follows its track.Rope is maintained the mucosa breakage that can help within the ring being caused by rope or equipment 120 drop to minimum level, and can also prevent that in addition rope or equipment 120 from interfering with endoscope's picture reproducer (for example, its photographing unit, CCD or fiber optic component).Be transported to the distal part of endoscope along with equipment 120, it can be formed to slide within the guided rings and put in place, shown in Fig. 2 B.Equipment 120 can also move with the distal part of endoscope is as one man crooked subsequently.Guided rings can be configured to permission equipment 120 and pass completely through guided rings.Fig. 2 C has shown to have for the tube chamber 202 of endoscope and be used for the guided rings 200 of the tube chamber 204 of equipment 120.Usually, guided rings is annular or sub-circular, and preferably has the minimum profile of wound, and wherein these rings comprise rounded edges, for example shown in the cross sectional top view among Fig. 2 D.Guided rings can combine with endoscope, and the binding agent by bio-compatible is attached to endoscope, be suitable for being snapped in the endoscope, perhaps above the combination of these modes.
Fig. 3 A-3G has shown and can be used in the guiding device 300 that equipment advance is surpassed the distal part of endoscope.Guiding device 300 comprises flexible or half flexible elongated member 302, fulcrum 304 and variable durometer cable 306.Elongated member 302 comprises distal part 310 and portions of proximal 312.The length of elongated member and diameter range can depend on the service aisle size of endoscope to be used and pending operation.Usually, the length range of elongated member 302 is to about 300cm from about 100cm.The scope of cross-sectional diameter is generally from about 1mm to about 3mm, and cross-sectional diameter preferably is configured for through the service aisle of endoscope and advances.One of skill in the art will appreciate that all sizes that provide at this only are intended to as an example, and the guiding device with different size can be substituted for concrete purposes.
Elongated member 302 comprises biocompatible material, and this material is wrapped variable durometer cable 306, and covers it in order to avoid directly be exposed to body area.This material for example can be expanded PTFE, politef, polyethylene or polypropylene.In an exemplary, elongated member 302 can by arrange at variable durometer cable 306 heat-shrink tube (for example politef heat-shrink tube) and after make the pipe pyrocondensation put in place and make.The elongated member can comprise one or more of materials, and described material provides the attribute of sufficient intensity, amount of deflection and resistance against compression for this member, in order to pass the meander region of body part.Such material comprises nylon, polyether block amide, polyethylene terephthalate, politef, polyether-ether-ketone or its compositions.Yet, one of skill in the art will appreciate that the elongated member can be formed by other biocompatible material structure well known in the art, in order to the attribute of expection is provided.
A plurality of parts of guiding device can be coated with one or more of materials.Preferably, at least a portion of elongated member 302 is coated with water wetted material or other lubriation material.Hydrophilic coating or other lubricant coating are considered to be convenient to make equipment to advance through body area or conductor equipment.In certain embodiments, fulcrum 304 can consist of and/or is coated with this material through its material that steadily advances by being convenient to rope.Preferred material comprises polyethylene (UHMWPE), nylon and the polyformaldehyde of politef, super high molecular weight.
In alternate embodiment, elongated member 302 can comprise the hole 318(Fig. 3 E-3F that serves as fulcrum 304).Hole 318 is positioned on the distal part 310, and is communicated with the tube chamber 316 of contiguous hole 320 extensions.Guiding device can utilize " short silk thread technology " to be retrofitted on the rope 104 in the proximal portion of endoscope.Especially, first end 105 can penetrate in the hole 318, penetrate into tube chamber 316 and penetrate into subsequently outside hole 320 and the hole 320.Afterwards, elongated member 302 can be pushed into through service aisle 110.Advance to surpass the distal part of endoscope along with the elongated member, rope preferably therewith is pulled, this rope from hole 318 around turning back.Guiding device can be retrofitted on the seal wire 350 according to same process.Yet, one of skill in the art will appreciate that guiding device can have hole and tube chamber by configuration, thereby can install equipment additional by short silk thread technology or long filament line technology if be fit to.Disclose this two technology in U.S. Patent Application Publication No.2007/0167923, its disclosure is included this paper in by quoting in full.
In case the distal part 310 of elongated member 302 arrives at target body part 380, then variable durometer cable 306 can be used for the sclerosis of elongated member and anchoring put in place (Fig. 3 G).Rope can be pulled through service aisle 110 from port one 14 subsequently, thereby advances connecting device 120 towards the target body part.Preferably, equipment 120 can utilize rope to be pulled at its distal end 126 places at it when proximal end 124 places are pushed.Promotion and pulling equipment can reduce the generation of the wound of being caused by the tissue around the lead-in path, and are convenient to advance reposefully.In certain embodiments, equipment 120 can comprise sclerosis or strengthen element, in order to be provided for the abundant rigidity of effective promotion for equipment.
In the process in the extension with endoscope and guiding device imports to the target body part, rope can be held fixing on demand.Preferably, the rope long enough, thus when being advanced to the target body part, endoscope and guiding device can keep control at place, two ends.In other words, rope is preferably more than the twice of endoscope's length.In utilizing the embodiment of guiding device, rope is preferably more than endoscope increases extending to outside the hole 112 and extending to the twice of length of the part of target body part of length and elongated member 302.The part of leaving port one 14 of rope can for example be passed through locking device (the Cook Endoscopy Inc. that for example, is located in the Winston-saran of the North Carolina state
Wire Guide Locking Device) or by the maintenance rope be held to be fixed on the port.Similarly, another end, particularly rope of rope externally advance to the part of portions of proximal 106 along endoscope can be by locking mechanism or similar devices or by keeping rope to be held fixing.Along with elongated member 302 or equipment 120 are advanced in the target body part, rope can be unlocked on demand.
Alternatively, comprise that the endoscope cap on slope can use with propulsion system, thereby help conveying equipment 120.Arrive at the distal part of endoscope 102 along with equipment 120, medicated cap just can be used for equipment is deflected in the target body part, and this target body part for example is ductus pancreaticus.Fig. 4 A-4B has shown that configuration is used for the endoscope cap 400 of duodenoscope.This medicated cap comprises the body 402 with proximal end 404 and distal end 406.Proximal end 404 comprises the hole 403 of the distal part that is configured to receive endoscope.Medicated cap 400 further comprises can be used in makes armarium towards the slope 405 of selected target body part deflection.Medicated cap 400 further comprises the picture reproducer (for example, photographing unit, CCD or fiber optic component) that is configured to hold endoscope and the lateral apertures 407 of service aisle.
In certain embodiments, medicated cap can comprise the bonding part 410 that is configured to medicated cap is fixed to endoscope.The bonding part can combine or be attached to the proximal end 404 of medicated cap this proximal end 404.Preferably can be formed by the flexible material structure that the friction inside diameter surface is provided in the bonding part that nearside extends from body 402.For example, the bonding part can be formed by the bright polyurethane structure that is molded into body 402.In other embodiments, it can for example be formed by silicone or another kind of flexible polymer structure, and this flexible polymer will provide installs also frictionally the ability that (but removedly) is attached to endoscope with medicated cap 400.
In alternate embodiment, comprise that the whole medicated cap of bonding part can be formed by constructed of rigid materials.Medicated cap can comprise arbitrarily suitable structure or the material that is configured to medicated cap is attached to endoscope.For example, medicated cap can comprise binding agent, magnet, thread surface, pawl structures or other structure and material well known in the art.In another alternative embodiment, endoscope can comprise near its distal end for the structure that engages medicated cap, for example the butterfly sheet/draw-in groove of complementary thread surface, interlocking or be configured to medicated cap is attached to the another kind of structure of endoscope.Can find the illustrative example of such bonding part in U.S. Patent Application Publication No.2009/0105539, its disclosure is included this paper in full by reference in.
Fig. 4 C-4E has shown another embodiment of the medicated cap 400 that comprises the slope 420 that is attached to pivotally medicated cap.The slope comprises cross walkway 422 and 424.Alternatively, each path separately can comprise metal sleeve 423 and 425.Slope 420 is attached to medicated cap pivotally by slope swinging mounting 426, and the part of this support partly arranges through cross walkway 424.Medicated cap may further include fixed ramp 428, this fixed ramp be configured to provide outer surface from endoscope to the slope 420 smooth transition section.
Fig. 4 D-4E has shown the medicated cap of Fig. 4 C on the distal end that is arranged on endoscope 102.Endoscope comprises lifter 430, and this lifter can be detachably connected to slope 420 by connecting rod 440.Lifter 430 comprises cross walkway 432,434 and 436.Alternatively, each path separately can comprise metal sleeve 433,435 and 437.Lifter is attached to endoscope pivotally by lifter swinging mounting 438, and the part of this support partly arranges through cross walkway 434.Lifter silk thread 439 is connected to lifter 430 at place, an end, and functionally is connected to the control system of the proximal portion that is positioned at endoscope at another place, end.The manipulation of control system so that the lifter silk thread move with respect to endoscope.When the lifter silk thread was retracted towards the portions of proximal of endoscope, lifter 430 was around 438 motions of lifter swinging mounting.Lifter can be used for making the equipment of carrying through service aisle 110 to deflect into anticipated orientation.For example, lifter can be used for seal wire 350 and guiding device 300 are deflected in patient's the gallbladder system.Can find that in U.S. Patent Application Publication No.2007/0208219 similar endoscope's lifter apparatus more specifically describes, its disclosure is included this paper in full by reference in.
Connecting rod 440 comprises elongated member 442 and two attached element 444(Fig. 4 F).Connecting rod can be attached to lifter 430 and slope 420 by attached element being inserted into cross walkway 422 and 432.Attached element 444 can be the cylindrical structural that is attached to elongated part 442 or combines with elongated part 442.Preferably, attached element can engage around its separately central axis axially-movable the time.For example, attached element can comprise by bearing separate outside and inner, bearing so that this outer peripheral rotate around attached element central axis.Attached element can comprise joint lifter 430 and slope 420 necessary any suitable structural details.For example, attached element 444 and cross walkway 422 and 432 can have complementary thread surface.
When lifter 430 and slope 420 by connecting rod 440 and when attached, the startup of lifter 430 so that slope 420 start.Fig. 4 D has shown lifter 430 and the slope 420 that is in the first configuration, and in this first configuration, lifter silk thread 439 is not retracted towards the portions of proximal of endoscope.Fig. 4 E has shown lifter 430 and the slope 420 that is in the second configuration, and in this second configuration, the lifter silk thread is retracted towards the portions of proximal of endoscope.When along the downward puopulsion equipment of endoscope, slope 420 can start to the second configuration from the first configuration, in order to make the equipment of being transferred towards the deflection of selected target body part.It will be understood to those of skill in the art that in some cases, slope 420 does not need to start to the second configuration from the first configuration fully, but can start to the needed configuration of concrete operation.
Alternatively, endoscope sheath can use with propulsion system, so that along endoscope's conveying equipment.Fig. 5 A has shown the sheath 500 with portions of proximal 502 and distal part 504.Sheath comprises for the first tube chamber 510 of endoscope and the second tube chamber 520 of the equipment that is used for being transferred along endoscope.Tube chamber 520 extends to distal part 504 from portions of proximal 502, and has the hole 522 that is positioned at the distally and the hole 524 that is positioned at nearside.As shown in the figure, endoscope 102 arranges through tube chamber 510, and sheath extends to its distal part 108 in endoscope's portions of proximal 106.The width of sheath and length range can depend on the size of endoscope to be used.Usually, the length range of sheath is from about 100cm to about 200cm, and the wall thickness of sheath is between the extremely about 8mm of about 0.1mm.In one embodiment, sheath can be formed by expanded PTFE (ePTFE) structure.
Alternatively, sheath can comprise the medicated cap member 530 of the distal end that is attached to endoscope 102, shown in the endoscope that the end among Fig. 5 A is observed.The medicated cap member can be the tubular structure with proximal end 532 and distal end 534.Proximal end 532 can be configured to engage the distal end of sheath.Alternately, medicated cap can be fixedly attached to the distal end of sheath.Distal end 534 can have and is configured to the opening 536 and 538 aimed at hole 112 and endoscope's picture reproducer respectively.
Medicated cap member 530 may further include the coupling member 540(Fig. 5 C that engages tube chamber 520 at hole 522 places).Coupling member 540 can be formed near the inner surface that frictionally engages tube chamber 520 hole 522.Coupling member comprises that proximal end 542, distal end 544 have extended to the tube chamber 546 of distal end 544 from proximal end 542 through it.Preferably, equipment 120 can be pushed into along endoscope through sheath lumens 520, enters tube chamber 546, leaves afterwards and enters in the body area.
Alternatively, sheath can comprise another coupling member 550, and this another coupling member is connected to tube chamber 520 at hole 524 places or is formed at hole 524 places and connects (Fig. 5 D) with tube chamber 520.Coupling member 550 comprises tube chamber 552, and equipment can be through this tube chamber 552 and being inserted into, and is pushed into towards the distal part of endoscope through tube chamber 520 afterwards.Coupling member 550 can be attached to the proximal end of sheath or combine with this proximal end.Preferably, coupling member 550 is configured to be attached to releasedly endoscope.For example, coupling member can be configured to frictionally engage the portions of proximal of endoscope and/or sheath.
Fig. 6 A-6H has shown the method that can armarium be imported to along endoscope the selected target body part.In an exemplary, propulsion system can be used with endoscopic retrograde cholangiopancreatography (ERCP).ERCP relates to: duodenoscope is inserted in patient's mouth and through esophagus, harmonization of the stomach duodenum, until its conduit that arrives at gallbladder system and pancreas leads to duodenal zone.The equipment that is transferred through endoscopic working channel can pass subsequently be used to the ampulla of vater that enters conduit system (Papilla of Vater).Wherein, these equipment can be used in and carry out diagnosis and treatment operation.The example of such equipment comprises seal wire, basket, snare, support, get stone sacculus, conductor brush, conduit and typically have a diameter from the baby endoscope of 0.8mm to 4mm.
An ERCP operation comprises that plastics gallbladder support is transported to narrow just to be blocked in the bile duct or ductus pancreaticus zone of drain.Obstruction may be caused by the tumor in bile duct or the ductus pancreaticus.Typically, arrived patient body when symptom occurring, tumor is in late period and is considered to and should not performs the operation.Therefore, the processing method of cancer concentrates on extenuating of symptom usually.As the replacement scheme for the surgery by-pass operation of extenuating, support can be carried by ERCP through barrier zone and be positioned, thereby keeps the path of passing through for fluid flow.Yet the maximum gauge of plastics gallbladder support depends on the diameter of endoscopic working channel usually.Therefore, in some cases, a plurality of supports must be arranged within the narrow, to allow abundant drain.Utilize propulsion system of the present invention, diameter can be transported to bile duct or ductus pancreaticus greater than the plastics gallbladder support of endoscopic working channel.These larger pipes can be convenient to carry out more fully the drain of conduit, and compare with its less counterpart and can be not easy to block.
Fig. 6 A-6H has shown large plastics gallbladder support 610 has been transported in the common bile duct.Operation is to arrange beginning in place with endoscope 102 and rope 104, as shown in Figure 1.Endoscope can be advanced to subsequently in the patient body and be positioned in the duodenum 602, in order to allow to observe Oddi's sphincter (Sphincter of Oddi) and the ampulla of vater 604, it is positioned at the opening part that leads to common bile duct 606 and ductus pancreaticus.Next, seal wire 350 can extend outside the hole 112, and the process ampulla of vater (Ampulla of Vater) also enters conduit system (Fig. 6 A).Preferably, seal wire is pushed into by narrow 608.Dilating catheter can be used for promoting to insert pipe at conduit on demand.Disclose the more specifically description of inserting pipe by means of dilating catheter in common bile duct in U.S. Patent Application Publication No.2005/0059890, its disclosure is included this paper in by quoting in full.Guiding device 300 can be installed in the proximal portion of endoscope on seal wire and the rope 104.The elongated member 302 of guiding device can be pushed into through endoscopic working channel, is extended out hole 112 afterwards outward and enters conduit system, advances (Fig. 6 B) via fulcrum 304 at seal wire all the time.Along with elongated member 302 is advanced in the conduit system, rope also will be pushed into contacting of fulcrum 304 by it.Preferably, fulcrum 304 is pushed into by narrow 608, puts in place thereby can be pulled when making the gallbladder support in being advanced to the target body part.In case elongated member 302 is advanced to desired location, variable durometer cable 306 just can be engaged by operated actuator 314, thereby so that elongated member 302 hardens (Fig. 3 A and 6B).Sclerosis can be in place with the elongated member anchoring, and the rigidity that prevents from occuring wrinkle in the process of conveying equipment 120 is provided.
Next, the gallbladder support can be connected to rope in the proximal portion of endoscope.Preferably, support is retrofitted to delivery conduit and is transferred via this delivery conduit, and this delivery conduit is configured to be connected to rope.Delivery conduit as equipment 120 comprises be used to the connection element 122 that is connected to rope, and preferably includes hardening component or partially rigid part, thereby can promote conduits from its proximal end 124.Promote support or delivery conduit and can reduce the tension force on the rope in importing process, and can reduce the generation of mucosa breakage.In case coupled, just can be by be in proximal direction pulling rope at port one 14 along endoscope's puopulsion equipment 120.
When arriving at the distal part of endoscope, by when utilizing rope 104 pullings, continuing to promote from proximal end, can advance delivery conduit along the elongated member 302 of guiding device 300.Preferably, delivery conduit is advanced to distal part 310, and is advanced to thus target body part (Fig. 6 C).In case delivery conduit arrives at target location (that is, narrow), it just can break away from from rope subsequently and connect.For example, thus when utilize enough power rope to be retracted throw off from connection element 122 when connection elements 116 make delivery conduit break away from from rope to connect at port one 14 places, delivery conduit can be maintained at proximal end.Rope can be drawn out outside the conduit system subsequently, and is pulled back in the endoscopic working channel 110.Guiding elements 300 and seal wire subsequently 350 can be advanced to outside the conduit system, and are pushed into and get back in the endoscope.Next, by utilizing interior ejector sleeve support is promoted out outside the delivery conduit, gallbladder support 610 can be transported to the position (Fig. 6 D) of narrow 608.Can remove delivery conduit from body area subsequently.One of skill in the art will appreciate that entering, carry, break away from and connecting and can change on demand from the step that the target body part removes of equipment.For example, if utilize seal wire to carry out complementary procedure, then preferably can be just from the bile duct seal wire of partly retracting.
In the alternate embodiment of above-mentioned ERCP operation, endoscope cap 400 and/or endoscope sheath 500 can use with propulsion system, so that equipment 120 is transported to narrow 608.Fig. 6 E has shown the endoscope cap 400 on the distal end that is arranged on endoscope 102.Along with it is transported to the distal part of endoscope, the angular movement of delivery conduit (equipment 120) is convenient on slope 405.Fig. 6 F has shown the endoscope with endoscope sheath 500.Delivery conduit is advanced to the distal part of endoscope through the tube chamber 520 of sheath.Fig. 6 G has shown endoscope cap 400 and the sheath 500 that is used in combination.In this embodiment, medicated cap comprises the coupling member 540 that is connected to tube chamber 520.Medicated cap comprises that also the tube chamber 546(that aims at slope 405 does not show), thereby in case equipment 120 leaves sheath lumens and tube chamber 546, thereby equipment just will intersect with slope 405 and be deflected.
Although described each embodiment of the present invention, those skilled in the art can exist more embodiment and implementation method within the scope of the present invention with clear.Therefore, the present invention only is restricted according to appended claims and equivalent thereof.
Claims (16)
1. propulsion system comprises:
Endoscope, described endoscope has portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, and described port is arranged on described proximal portion and is communicated with described service aisle; And
Rope, described rope extends to described distal part and extends to described hole from described portions of proximal in described endoscope outside, and extends to described portions of proximal from described hole through described service aisle.
2. propulsion system according to claim 1, wherein said rope comprises and is constructed to the connection element that connects with armarium, and wherein said connection element comprises closed-loop structure, the releasable stitching thread that maybe can rupture, temporary transient or soluble binding agent, binding agent, magnet or its combination.
3. propulsion system according to claim 1, wherein said rope comprises hydrophilic or lubricant coating.
4. propulsion system according to claim 1, wherein said rope is selected from silk thread, belt, filament or stitching thread.
5. propulsion system according to claim 1, further comprise at least one guided rings, described at least one guided rings is arranged on the outer surface of described endoscope, and is configured to guide described rope from described portions of proximal to described distal part along described endoscope.
6. propulsion system according to claim 1 further comprises guiding device, and described guiding device comprises:
The elongated axle, described elongated axle has axle portions of proximal and axle distal part; With
Fulcrum, described fulcrum are arranged on described axle extremity office and are configured to receive described rope,
Wherein said elongated axle comprises the variable durometer cable, and described variable durometer cable comprises:
Helical spring, described helical spring extends to described axle distal part from described axle portions of proximal;
Silk thread, described silk thread extends past described spring, and described silk thread functionally is connected to described spring in described axle extremity office; And
Actuator is connected to described actuator operated described silk thread, and is set to contiguous described axle portions of proximal, and the startup of wherein said actuator is so that described spring is compressed.
7. propulsion system according to claim 6, wherein said fulcrum is made of the wherein a kind of structure in single ring architecture, twin nuclei or the cylindrical structural.
8. propulsion system according to claim 6, wherein said elongated axle comprises hydrophilic or lubricant coating.
9. propulsion system, be configured to use with endoscope, described endoscope comprises portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, described port is arranged on described proximal portion and is communicated with described service aisle, and described propulsion system comprises:
Rope, described rope extends to described hole from described portions of proximal to described distal part in described endoscope outside, and extends to described portions of proximal from described hole through described service aisle; And
Guiding device comprises:
The elongated axle, described elongated axle has axle portions of proximal and axle distal part;
Fulcrum, described fulcrum are arranged on described axle extremity office and are configured to receive described rope;
The variable durometer cable, described variable durometer cable is set to through described elongated axle, comprise helical spring and silk thread, described helical spring extends to described axle distal part from described axle portions of proximal, described silk thread extends past described spring, and described silk thread functionally is connected to described spring in described axle extremity office; And
Actuator is connected to described actuator operated described silk thread, and is set to contiguous described axle portions of proximal.
10. propulsion system according to claim 9, wherein said fulcrum comprises the wherein a kind of structure in single ring architecture, twin nuclei or the cylindrical structural.
11. propulsion system according to claim 9, wherein said elongated axle comprises the first hole, described the first hole be positioned at described axle extremity office and with the second porosity communication, described the second hole is set to contiguous described the first hole and is positioned at described axle extremity office.
12. propulsion system according to claim 9, at least a portion of wherein said elongated axle comprises hydrophilic or lubriation material.
13. propulsion system according to claim 9, the diameter range of wherein said fulcrum are to about 3mm from about 1mm.
14. propulsion system according to claim 9, wherein said elongated axle comprises hydrophilic or lubricant coating.
15. propulsion system according to claim 9, wherein said rope is selected from silk thread, belt, filament or stitching thread.
16. propulsion system according to claim 9, wherein said rope comprises hydrophilic or lubricant coating.
Applications Claiming Priority (7)
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| US61/288,259 | 2009-12-18 | ||
| PCT/US2010/060442 WO2011075510A2 (en) | 2009-12-18 | 2010-12-15 | Advancing system and method of use thereof |
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| CN201080063845.5A Active CN102834042B (en) | 2009-12-18 | 2010-12-15 | The sloping endoscope cap of tool |
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